Assessing the Role of State and Local Public Health in Outreach and Enrollment for Expanded Coverage

A Case Study on New Orleans, Louisiana

by Malcolm V. Williams, Christian Lopez, Laurie T. Martin, Courtney Armstrong

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Research Questions

  1. What innovative models and best practices in New Orleans, Louisiana, can leverage local health departments' involvement in Patient Protection and Affordable Care Act outreach and enrollment?
  2. How can state or local public health entities and agencies in New Orleans, Louisiana, serve as a gateway to identifying and enrolling eligible individuals in the expansion of Medicaid and the implementation of the health insurance marketplace?
  3. Are there barriers or facilitators to full engagement in outreach to and enrollment in Medicaid expansion and the health insurance marketplace by public health?
  4. What role can public health play in maintaining enrollment?

The Patient Protection and Affordable Care Act (ACA) laid the groundwork for a substantial increase in the number of people who have access to health insurance through Medicaid expansion or health insurance marketplaces. During the first open-enrollment season, states used a variety of strategies to reach out to and enroll newly eligible people. Typically, they used federal and state funding to develop navigator programs. Program design differed by location, and, although many stakeholders were involved in these efforts, state and local health departments (LHDs) were, and remain, a relatively untapped resource. This report is one in a series designed to highlight innovative models and best practices that leverage LHD involvement in ACA outreach and enrollment and to facilitate knowledge transfer to other geographic regions looking to leverage the full range of roles for LHDs in ACA outreach and enrollment. Each case study was designed to capture nuanced differences in how health departments support these efforts in their communities, identify facilitators and barriers to these approaches, and develop lessons learned from these activities. These reports identify compelling models for how state and local health departments can implement similar activities in their own communities. Further, they provide guidance and insight into the role LHDs can play now, and help redefine that role in the future, as states continue to enroll residents in health insurance coverage moving forward. This report focuses on a case study on New Orleans, Louisiana.

Key Findings

The New Orleans Health Department's History of Improving Access and Partnering with Community-Based Organizations Helped Outreach and Enrollment

  • With 504HealthNet, a private not-for-profit membership organization for the region's community health centers, the New Orleans Health Department led an outreach and enrollment work group.
  • The department also made use of public health data and mapping to support its outreach efforts. It conducted both direct and indirect outreach and enrollment, and it leveraged its network to increase enrollment opportunities.

Outreach and Enrollment Efforts Face Challenges at the Individual and Policy Levels

  • Individual barriers included the population's low levels of health, computer, and insurance literacy; the cost of insurance; and the time and effort required to enroll.
  • When Medicaid was not expanded in Louisiana, a gap in coverage occurred for some people who had previously been able to access coverage through a Medicaid waiver program. Also, about 40 percent of the uninsured would have been eligible for Medicaid under expansion; many of these people seek care primarily through community health centers.

Some Factors Help Those Efforts

  • The primary facilitator of these activities is the large network of partnerships on which the health department could draw to enhance outreach and enrollment. Also, although the state did not support expansion of the Patient Protection and Affordable Care Act, residents of New Orleans were generally in favor of the act. The city is generally "pro-Obama" and, as a result, supported implementation activities, such as the enrollment events.

Recommendation

  • The LHDs will need to work with health plans to ensure that the CHCs are in the networks of newly insured plan members and work on information campaigns to educate consumers about how to use health insurance.

Research conducted by

The research described in this report was conducted by RAND Health.

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